NPIMap

Organization Active NPI

James K McPhelan OD PC

  • Optometrist
  • Phoenix, AZ
National Provider Identifier
1962677328
Registry record updated Apr 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1020 Issued in AZ
Legal business name
JAMES K MCPHELAN OD PC
Practice address
16429 N Tatum Blvd
Phoenix, AZ 85032-3458
Phone
(480) 889-6044
NPI assigned
Apr 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bryan Fuller, O.D.NPI 1285682146
Title
Vice President
Phone
(480) 889-6044

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1020 AZ Primary

Addresses

Primary practice location

16429 N Tatum Blvd
Phoenix, AZ 85032-3458

Mailing address

16429 N Tatum Blvd
Phoenix, AZ 85032-3458
Phone (480) 889-6044

Other names 1

  • Tatum EyeCare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080814000742 AZ Part B Supplier - Clinic/Group Practice 3375618002 Receives reassigned benefits from 7 practitioners
Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory

Locations

16429 N Tatum Blvd
Ste 2
Phoenix, AZ 85032

21050 N Tatum Blvd
Ste 120
Phoenix, AZ 85050
Phone (480) 889-6044

16429 N Tatum Blvd
Phoenix, AZ 85032
Phone (480) 889-6044

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461283200000",
    "number": "1962677328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16429 N TATUM BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323458",
            "telephone_number": "480-889-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16429 N TATUM BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850323458",
            "telephone_number": "480-889-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES K MCPHELAN OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2016-04-22",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "480-889-6044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tatum EyeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.